‘The difficult is done at once, the impossible takes a little longer…’
For the record, the derivation;
'1794, Charles Alexandre de Calonne, the controversial Finance Minister for Queen Marie Antoinette… later, the French Revolution swept the Queen from power, and died on the guillotine in 1793.'
The phrase has a resonance to it, the ring-of-now.
There are nearly 5 million people waiting for an operation in the English NHS. To be honest, I’m not convinced that is the right figure, I’d guess a lot more. Any-road-up…
… the impossible will take a little longer and there is no ‘little longer’.
The NHS does ‘difficult’ with alacrity and will scythe through the numbers, eventually but with the prospect of a general election in about 1,000 days from now, BoJo will want to get the numbers back to when Labour's Andy Burnham was SoS Health…
… August 2009; 550,000 people were waiting for hospital treatment in October. A total of 32,900 waited over 13 weeks, 56 had to wait more than 26 weeks.
Happy days!
Waiting lists are not static. It’s all about the Five Gets;
Get in (Waiting to access the system)
Get diagnosed (Out patients, diagnostic, tests)
Get fixed up (Admitted and procedure complete)
Get out (Safe discharge)
Get on with yer life (Rehab…)
Do that for one person and before you know it, their place has been taken by another, probably two others.
Could be six?
There are over 10 million operations a year, in roughly 3,000 operating theatres. Generally, two million are urgent, get done at once. Five million+, waiting now, plus eight million… do the maths.
BoJo is in Marie Antoinette territory. The NHS will do-for-him at the polls, unless he can fix the waiting lists.
If the NHS is to do the impossible it’s about productivity. I know the NHS works flat out… productivity is not about that. Productivity is all about making work quicker and slicker. Easier and right-first-time.
Productivity means helping people to do more with better systems, decision support, technology and a redesigned, faster trained workforce... starting with a skills-4-future, review.
NHSE's latest wheeze is ‘a network of accelerator areas’, to pilot new initiatives, including extra clinics at weekends, virtual assessments at home and new clinics that are effectively cataract factories.
Note: the announcement wasn’t made by outgoing Simon Stevens, it was made by NHSE, COO Amanda Pritchard, on manoeuvres for the top job, she added;
‘With Covid cases in hospitals now significantly reducing, our focus is on rapidly recovering routine services.’
… there’s a surprise!
We don’t need pilots, Amanda, we need tank-drivers, to bulldoze the bureaucracy, combine harvester operators to gather up the talents and audit just what capacity we have and supply-chain managers to make the system work as a whole.
It’s about people and places… there are not enough people and not enough places to look after too many people who end up in the wrong places.
Think Four I’s;
Infection Control
Right now, hosptials toil under the same social distancing palaver as the pub and a hairdressers.
Productivity is squeezed as beds-spaces are increased, outpatients facillities are working at about a third of their capacity and everyone, including the back office is wearing masks.
We must change the covid regulations to allow the NHS to work differently. We have enough infection control people to, safely, change the rules for the NHS and get back to normal running.
Innovation
Forget pilots, we know what works. Remote out-patients, home testing, pre-admission work-ups, self admission, distance consultations… Covid gifted it to us.
The road bloc is the tariff. Find out where it needs to be changed to make ideas stick and incentivise change.
Identify supply chain fixes
The clue is in the title , look at the NHS as a national asset. Everyone doing everything, everywhere makes no sense.
Regional centres of excellence for hips and whatever. Give patients mobility allowances to travel with a relative or carer.
Examine every interface in the chain, from the first GP appointment, to the final sign-off. Forget pathways, we need a supply chain expert, not a park-keeper.
Involve patients
This is the most critical and where the pressure will come from via MPs in-boxes, the front page of the Red-Tops and the 6 o’clock news.
Write, email, ring-up and tell people where they are in the system and what they can be doing to make the wait more bearable and be fit and ready for the Z in zonked, when they are on the operating table.
Start with the necessary, that’ll help you do the possible. Do that and it will show you how to do the impossible.
>> I'm hearing - A small number of "unusual infections" have been identified in patients at the Royal Aberdeen Children's Hospital. Investigations are ongoing to see if there is any link to the hospital environment.
